鼻整形术中导航截骨术的准确性：一项尸体分析

文献信息

中文摘要

背景： 导航引导的鼻整形术允许对截骨术进行详细规划和引导。我们旨在研究使用CT导航系统是否可行，以及是否能够在特定位置执行更精确的截骨术，从而提高准确性。
方法： 在九个尸体头部上进行了双侧电磁导航鼻上颌缝截骨术（n = 18），采用经鼻（n = 4）或经皮（n = 14）技术。解剖后，我们在（n = 5）个标本上手动评估了截骨与骨缝之间的距离。此外，在基线和术后进行了锥形束计算机断层扫描，以计算截骨与骨缝线之间的平均距离和中位距离。
结果： 手动测量的预期与实际截骨之间的平均距离为0.75 mm（95%置信区间[CI] 0.06-1.44 mm），中位距离为0.00 mm（四分位距[IQR] 0.00-1.19 mm）。在10次手术中的6次，截骨按计划创建，没有可见偏差。总体而言，在影像上，导航引导的截骨术与骨缝的平均偏差为1.50 mm（95% CI 0.87-2.12 mm），标准差（SD）为1.35 mm。中位距离为0.73 mm（IQR 0.59-2.61 mm）。经鼻和经皮截骨术的准确性相似（p = 0.63）。
结论： 导航引导的截骨术显示出良好的可行性，经皮和经鼻技术均具有临床有用的亚毫米级准确性。描述了一种用于术后结果分析的模型，具有临床有用的准确性，但不如直接观察那么高。
证据等级： 不适用。

英文摘要

BACKGROUND: Navigation guided rhinoplasty allows detailed planning and guidance of osteotomies. We aimed to investigate whether the use of a CT navigation system is feasible and capable of performing more precise osteotomies at specific locations, thus improving accuracy.
METHODS: Bilateral electromagnetic-navigated osteotomies (n = 18) of the nasomaxillary suture were performed on nine cadaver heads, using a transnasal (n = 4) or percutaneous (n = 14) technique. After dissection, we manually assessed the distance between the osteotomy and the suture on (n = 5) specimens. Additionally, at baseline and postoperatively, a cone beam computed tomography was performed to calculate the mean and median distance between the osteotomy and the suture line.
RESULTS: The manually measured mean distance from intended to actual osteotomy was 0.75 mm (mm) (95% confidence interval [CI] 0.06-1.44 mm) with a median distance of 0.00 mm (interquartile range [IQR] 0.00-1.19 mm). In 6 of 10 procedures, the osteotomy was created according to plan with no visible deviation. Overall, on imaging, the navigation-guided osteotomies deviated from the suture by an average of 1.50 mm (95% CI 0.87-2.12 mm) with a standard deviation (SD) of 1.35 mm. The median distance was 0.73 mm (IQR 0.59-2.61 mm). The accuracies of transnasal and percutaneous osteotomies were similar (p = 0.63).
CONCLUSION: Navigation-guided osteotomies demonstrated good feasibility with clinically useful sub-millimeter accuracy for both percutaneous and transnasal techniques. A model for postoperative outcome analysis is described with clinically useful accuracy, though not as high as direct observation.
LEVEL OF EVIDENCE: N/A.